International Health Systems Research Articles

COMPARISON OF TEMPORAL TRENDS IN THE GLOBAL BURDEN OF TRACHEA, BRONCHIAL, AND LUNG CANCER

Trachea, bronchial, and lung (TBL) cancers are significant public health problems among the leading causes of death in Turkey and the world. In this study, it was aimed to determine and evaluate the temporal trends of incidence, mortality, and DALY rates of TBA cancers between 1990 and 2019. Mortality-Incidence Ratio (MIR) and Joinpoint Regression Analysis (JRA) methods were used in this study. Incidence, mortality, and disability-adjusted life-years were used as variables in the study. The temporal trends of TBL cancers were compared between the global, Turkey, and Socio-Demographic Index (SDI) groups. In this study, it was determined that the age-standardized global burden of TBL cancers tended to decrease between 1990 and 2019. While the burden of TBL cancers tended to decline in high SDI countries during this period, it tended to increase in low SDI countries. In Turkey, while the TBL cancers burden decreased until 2005, it increased after 2006. While the global cancer burden of TBL tended to decline in men, it tended to increase in women during this period. According to the data obtained from the research findings, the burden of TBL cancers tends to decrease globally. However, it tends to increase in low and low-middle SDI group countries. To reduce the TBL global cancer burden, it is recommended that health policies should be developed in both Turkey and international health systems for fair access to cancer treatment.

The impact of COVID-19 on international development aid and health systems strengthening in low-income countries.

Health systems play a critical role in providing services that aim to improve, promote, restore, or maintain the health of communities. Unfortunately, health systems in low-income countries are fragile, having an adverse effect on the health of the population. Whereas international development aid remains crucial in strengthening health systems in low-income countries (LICs), COVID-19 has induced changes in the dynamics in the availability, provision and access to international development aid. These changes have aggravated the already weak health systems of LICs. Understanding the effects of the COVID-19 pandemic on the distribution of international development aid and how these effects impacted on the quality of the health systems in response to the outbreak is critical to improving the health of populations in LICs. This article discusses the impact of the challenges faced by LICs in the context of international development aid needed for the development of health systems.

'Single-handed care' initiatives and reviews of double-handed homecare packages: A survey of practices in English local authorities with adult social care responsibilities.

International health and social care systems are experiencing unprecedented pressure and demand. 'Single-handed care' initiatives seek to identify whether all or part of a homecare package involving more than one care worker can be safely reduced to a single worker. Little is known about these initiatives across local authorities. The aim of this study was to identify, describe and explain current processes and practices for single-handed care initiatives and double-handed homecare reviews. An electronic survey link was sent to each local authority with social care responsibilities in England. The questions covered a range of areas in relation to single-handed care processes and included a combination of pre-coded and free-text responses. Responses were received from 76 (50%) local authorities. Findings were that over 12,000 reviews were reported within a year with a median of 141 (IQR 45-280) from 53 authorities that provided figures. Reviews were usually led by a local authority occupational therapist. On average, 540 min was spent per review, including conducting and organising the review, documentation, and travel. In nearly half the authorities, double handed care remained at least partially in place following at least 80% of the reviews and remained wholly in place following at least 60%. Local authorities also reported some resistance from homecare providers when implementing single-handed care. The findings have confirmed anecdotal evidence that reviews of double-handed homecare packages are common practice within local authorities. Given the amount of time taken with these reviews, and paucity of evidence on outcomes for people receiving them, further research should evaluate this.

284 Effectiveness of Webinar to Provide an Insight on the UK Surgical Training Pathways for the International Medical Graduates (IMGs) From Lower- & Middle-Income Country (LMIC)

Abstract Aim To provide an insight on the UK- Surgical Training Pathways for the International Medical Graduates (IMGs) from Lower- & Middle-Income Country (LMIC's). To eliminate the barriers for the effective and safe patient care. Method A webinar “PLAB & Beyond” was organised by Nepalese Doctors Association-UK on 11thDec.2021 to provide an insight on various aspects of NHS and Training application process for Aspiring Surgeons from LMIC's. Virtual sessions were designed to share the first-hand experience by IMG's on varied NHS roles. A tailored session on Surgical Training pathways and application process was delivered by the IMG currently on the General Surgery Training Pathway. Results There were 70 participants of various grades joining from 3 different continents. The pre-webinar questionnaire suggested that almost 85% of the IMG's were not oriented regarding the General Surgery Training Pathways. Only 30% had a very limited idea about the Surgical-Portfolio Scoring system. 55% thought it was impossible to get into the Surgical Training Pathway in the UK for an IMG. Post webinar feedback suggested that majority of the attendees (∼95%) acknowledged that the webinar enhanced their understanding of NHS and Surgical Training Pathway meeting the aims & learning outcomes. Conclusion As IMGs from LMIC's contribute to major work force in the NHS, proper orientation to the training pathways must be added during local hospital induction. These session in broader sense will also aid to provide improved and equitable surgical care across international health system advocating Global Surgery, the ‘Neglected stepchild of global health’.

The effects of multi-disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK.

Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints.

Tau fifine Niue and the use of digital health tools: An intergenerational view

Introduction: Digital health technologies are rapidly changing the landscape of how healthcare is being delivered globally.Many international health systems are using digital technology to assist with delivery of information and healthcare, to enable more affordable, accessible, and acceptable care to manage key health priorities pertaining to that population. The key to success for any digital health approach for Pacific and ethnic-specific communities is ensuring digital inclusion is considered alongside the wider influences of health (family, cultural, economic, social, environmental). Digital technology could be the enabler to reduce inequities in health outcomes in some populations. The aim of this paper is to explore how an intergenerational group of tau fifine Niue (Niue women) use digital health tools for health and wellbeing. Methods: Tutala (similar to talanoa in the Samaon language) a culturally appropriate method of conversation with Niue communities was used to guide the research approach with a tau fifine Niue (n=40). Six group tutala were undertaken with tau afine (young women), tau mamatua fifine (mothers), and tau mamatua tupuna fifine (older women). Results: Three overarching themes were identified: (1) convenience of mHealth tools; (2) access to health information and resources; and (3) digital disconnection. There were differences in the adoption and use of digital tools for health-related purposes, which varied from using the internet, text messaging and health monitoring apps. Although tau afine and tau mamatua fifine were more likely to utilise digital health tools, it was clear not all tau mamatua tupuna fifine experienced the same benefits. Conclusion: Supporting digital inclusion, digital skills, and digital health literacy for tau fifine Niue using an intergenerational approach can translate into health benefits for Niue families and communities. As more and more health services turn todigital technology to assist with delivering health information and care, it is critically important digital technology is delivered in an equitable way that benefits all people, including multi-ethnic populations in Aotearoa, New Zealand.

Sequencing and phylogenetic analysis of the ORF3a gene variant B.1.1.7 SARS-CoV-2 virus

The problem of "new" infectious diseases has now acquired particular relevance for national and international health systems. One of these infections is the SARS-CoV-2 coronavirus. Due to the rapid spread of a new type of coronavirus in the world, molecular genetic studies of this virus are of great importance. This will help to understand the nature of the virus and develop antiviral drugs to prevent the disease. The aim is to identify a missense mutation in the ORF3 gene of the studied coronavirus strain SARS-CoV-2/human/KAZ/Britain. This paper presents the results of the development and sequencing of the ORF3 gene of the coronavirus strain SARS-Cov-2/human/KAZ/Britain. For the development and sequencing by the Sanger method of the ORF3 gene, 4 pairs of primers were developed, with an overlap of 100-150 bp. The changes in the ORF3 gene compared to other strains whose data were obtained from the GISAID database were analyzed. As a result, the obtained amino acid sequences of the ORF3a gene of variant B.1.1.7 were compared with the reference strain HCoV-19/Wuhan/Hu-1/2019, where one mutation was determined at position 149: W (tryptophan) → L (leucine). The phylogenetic affiliation of the studied virus strain was also determined, where the genetic distance between the studied strains of the SARS-CoV-2 virus was determined. Thus, the greatest similarity with the studied strain were: HCoV-19/Wuhan/Hu-1/2019, HCoV-19/England/MILK-9E05B3/2020, HCoV-19/Japan/IC-0446/2020, HCoV-19/Germany/NI-IOV-MHH15/2020, and the strain HCoV-19/Argentina/PAIS-F0418/2021 significantly distanced itself from the SARS-CoV-2/human/KAZ/Britain strain.

The demographic effects and public health infrastructure dearth of COVID-19 in Ghana

Background: Over the last two years, the world has been experiencing a worldwide health catastrophe. The Corona Virus (COVID-19) struck at the heart of societies and is a major health-care infrastructure problem. Infrastructure has been characterised as the basic requirement for carrying out productive and relevant public health actions. Mortality has direct and indirect relationship, with the former causing short and long-term mortality, resulting in a short life expectancy. Reduced accessibility and quality of health care, isolation, loneliness, and poverty were some of the indirect repercussions. The outcomes were sad and deeply felt when the two collided with ageing and persons with co-morbidities. The fertility effect of COVID-19 in the short-term on contraception presented itself in increased difficulties in accessing services and disruptions in the supply chain. Migration was mainly affected due to travel bans and restriction of movements through stay-at-home instructions.Methods:This paper uses the qualitative paradigm of research that used corpus construction in the selection of material to represent a whole and this make it functionally equivalent to sampling but structurally different. It used secondary data to ascertain the demographic effects and the extent of health infrastructure deficit and ingenious ways to curb the challenges as exposed by the COVID -19.Results:The study underscores how demographic factors can be disrupted by pandemics to bring about high rates of mortality. Global health function is under-funded and under-produced, as a study by the World Health Organization suggests.Conclusions: The study brings to bear that anthropogenic activities, air greenhouse gases, lifespan and hospital beds are key drivers of COVID-19 growth. The path forward to mitigate such pandemics is international harmony and alliances in the distribution of vaccines, strengthening of international health systems ability to hold back major infectious disease, addressing service quality and providing key financial injection.

Rehabilitation Through Physical Activity and Sport in Light of the International Classification of Functioning, Disability, and Health-Current Research Perspectives.

The implementation of functioning by the World Health Organization (WHO) as the third global health indicator, along with mortality and morbidity, represents a promising advancement for a comprehensive assessment of international health systems and health strategies. The description of a person's health state operationalized by both biological and lived health via functioning provides a holistic picture of an individual's life situation and proved to be successful in building a framework for formulating therapy goals, achievable activities, and participational aspects against the background of an individual's life situation. Furthermore, improving an individual's functional ability and wellbeing could potentially affect the health indicators of morbidity and mortality and will be codable beyond the ICF in ICD-11. This methodological perspective emphasizes the use of ICF applications on the wider and narrower level of international rehabilitation systems and highlights the incorporation of the term functioning in rehabilitation through physical activity and sport. Current research perspectives in applying the ICF and functioning in clinical and rehabilitation practices are discussed and a current explorative study is presented, which applies the holistic orientation of functioning and the biopsychosocial model to the specific case by an individualized sports coaching intervention in rehabilitation. Subsequently, a unifying ICF- oriented language in rehabilitation is considered as a powerful foundation for a consistent international research strategy concerning increased international collaborations and future research perspectives.

Real-time data of COVID-19 detection with IoT sensor tracking using artificial neural network

The coronavirus pandemic has affected people all over the world and posed a great challenge to international health systems. To aid early detection of coronavirus disease-2019 (COVID-19), this study proposes a real-time detection system based on the Internet of Things framework. The system collects real-time data from users to determine potential coronavirus cases, analyses treatment responses for people who have been treated, and accurately collects and analyses the datasets. Artificial intelligence-based algorithms are an alternative decision-making solution to extract valuable information from clinical data. This study develops a deep learning optimisation system that can work with imbalanced datasets to improve the classification of patients. A synthetic minority oversampling technique is applied to solve the problem of imbalance, and a recursive feature elimination algorithm is used to determine the most effective features. After data balance and extraction of features, the data are split into training and testing sets for validating all models. The experimental predictive results indicate good stability and compatibility of the models with the data, providing maximum accuracy of 98% and precision of 97%. Finally, the developed models are demonstrated to handle data bias and achieve high classification accuracy for patients with COVID-19. The findings of this study may be useful for healthcare organisations to properly prioritise assets.

Global Surgery: advent of a new discipline

Global surgery is a rapidly developing multidisciplinary field, aiming to provide equitable and improved surgical care across international health systems often with a focus on underserved populations of low- and middle-income countries1. History is witness that Christian Missionaries, International Committee of the Red Cross, Aga Khan Foundation and Islamic Association of North America have been offering humanitarian health support, including Surgery, to the needy since long. These were joined by League of Nations Health Organization (since 1920; later became the World Health Organization in 1946) and Médecins Sans Frontières (since 1971)2. However, Surgery remained ‘The neglected stepchild of global health’3. Main reason for this was lack of data leading to knowledge gap about the magnitude of the problem. The much needed catalyst for development of Global Surgery was the launch of Lancet Commission on Global Surgery report in January 20144. This report provided the much needed data about unmet needs of Surgery which grabbed the World’s attention: 5 billion people not having access to safe, timely affordable surgery and anaesthesia; leading to 18.6 million preventable early deaths each year - more than the number of people who die from HIV/AIDS, malaria and tuberculosis combined; millions of patients facing catastrophic expenditures when faced with surgical costs and many low- and middle-income countries likely to lose up to 2% of GDP due to loss of proper surgical care leading to loss of productivity. They also predicted that to reach the necessary levels of access to surgery by 2030 would require an investment of $420 billion, which would save an estimated $12 trillion in lost GDP over the same period, making it a very sound investment. And global burden of surgical disease was estimated to be ~ 30%5.

Impact of COVID-19 on Oral Cancer Diagnosis: A Systematic Review

The Coronavirus-19 pandemic has led to severe collapses in international health systems that have repercussions at all levels of disease prevention. Oral squamous cell carcinoma (OSCC) is the most common head / neck malignancy, and it is usually diagnosed late due to patients neglecting symptoms. The purpose of this systematic review is to verify the impact of Sars-Cov-2 pandemic on OSCC diagnosis. The search methodology follows the PRISMA statement performing a PubMed investigation from 2019 to 2021 using MeSH such as “Covid-19; oral cancer”. A multidisciplinary approach would be effective, with a broadening of the knowledge of health professionals to identify cancerous lesions. A timely diagnosis of OSCC is crucial and its management is fundamental also for dental specialists. With the aim to anticipate the diagnosis, it will be desirable to set prevention campaigns also by the assistance in telemedicine.

Monoclonal Antibody Cocktail therapy for COVID-19: A Pharmacological innovation

The novel SARS-CoV-2 infection has ripped through international health systems and protocols causing unprecedented mortality, morbidity and global trade deficits amounting to billions. Various monoclonal antibodies have been proposed for use in the treatment of COVID-19 infections. One such drug is LY-CoV555 which in an ongoing phase two trial study conducted by Chen P et al, showed to have an elimination of 99.97% of the viral RNA. The monoclonal antibody 47D11 discovered by Wang et al, binds to SARS-CoV-2. The 47D11 has been reconfigured into a human IgG1 isotope. It has shown that the 47D11 mAb effectively neutralizes the SARS-COV-2 virus. The stance and development however for the treatment of COVID-19 with monoclonal antibodies has shifted from a monotherapy to a so-called monoclonal antibody “cocktail” therapy.
 REGN-COV2 is such a cocktail developed with the use of two monoclonal antibodies REGN10987 and REGN10933 which have subsequently been named Imdevimab and Casirivimab. REGN-COV2 is currently under study in four phase 2 and 3 trial studies. These studies are multicentric in nature and are being conducted to evaluate the drug’s efficacy, dosing and clinical use as compared to the placebo. The mechanism of action of such monoclonal antibodies is related chiefly to the inhibition of the virus’s ability to perform its invasion and multiplication within the human body.
 The severity coupled with the sheer novelty of the SARSCoV-2 virus demands the use of newer therapies to both decrease the mortality and morbidity in patients suffering from the infection. The use of a combination of monoclonal antibodies is thereby well established and evident to both decrease the viral infection load, but is also useful in disrupting the virus’s life cycle and thus decreases the replication and viral shedding. It is therefore poignant that a combination of monoclonal antibodies, a “cocktail” therapy is employed so as to attack the virus at its various stages and thus this multifaceted approach may enhance the patient’s prognosis.

National Health Systems Response to COVID-19 Outbreak, Iraq an Example

This article describes chronologically the development of COVID-epidemic in Iraq, mainly Basra Province, and the response of the national and provincial health system response to control this crisis. It points some strengths and weaknesses of this response. In addition, it mentions some of the opportunities that need to get benefit from, including following an evidence-based approach in epidemic control management. Some of the international assessments' results showed that the performance of Iraqi health system come at the tail of the sorted list of international health systems. This necessitates conducting a scientific systematic evaluation to the national performance to precisely quantify structural and process strengths and weaknesses.

Solidarity and Voluntarism Amid the COVID-19 Pandemic: Skin Cancer Screening for Blood Donors.

Many of the volunteer activities required to raise public awareness on skin cancer screening and prevention are supported by dermatological societies and volunteer dermatologists, and are framed by substantial voluntary groups, often not sufficiently credited for their contribution, including blood donors and Red Cross Samaritans. We herein propose that amid the ongoing pandemic, skin cancer screening and blood donations must not be disrupted with attention paid to patient safety foremost. Although efforts over the last decade have led to a significant reduction in skin cancer, ongoing activities have been suspended and, in many cases, disrupted since the coronavirus disease 2019 (COVID-19) spread has created a Public Health Emergency of International Concern. International Health systems are burdened, and patients ignore symptoms and evade specialist visits due to contamination fear of coronavirus, resulting in a 68.61% reduction in skin cancer diagnoses. However, the COVID-19 pandemic has also major implications for blood transfusion. Currently, there are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. Supporting volunteer blood donors through voluntary skin cancer screening could be an excellent initiative, bringing people together, giving us the opportunity to abandon the illusion of power and admit our weakness to the ongoing pandemic. Most of us have not worked through pandemics before but it is time to embrace humanity and solidarity via volunteering, with no profit aims but with social goals of equal skin cancer screening opportunities of vitally important volunteer blood donors, encouraging blood donation. In light of a change in dermatology practice, investing in prevention strategies in public health and social protection is the mark of responsible policy action.

Complementary and alternative medicines use in COVID-19: A global perspective on practice, policy and research.

The COVID-19 pandemic has met international health systems with a low level of preparedness and emergency response. While the emergence of effective vaccines has offered the Governments, scientific communities, and members of the public a possible way out of the pandemic, effective pharmacotherapy, including immunotherapy for COVID-19 prevention and treatment, are yet to be established. Internationally, this has led to a surge in the demand and supply of many complementary and alternative medicines (CAM) and practices. Recent studies have shown increasing CAM information requests made to pharmacists and other healthcare staff from members of public and patients aimed at prevention, symptoms relief or treatment of COVID-19.In this context, it is imperative that healthcare professionals, including pharmacists, are acquainted with current practices, policies, and research in relation to CAM use in COVID-19. This narrative commentary will provide an update on global practices, policies and research in regards to CAM use in the context of COVID-19. Healthcare professionals’ understanding of popular CAMs and those tipped for potential benefits in COVID-19, patient and consumer behaviors in relation to CAM use; and healthcare professionals' awareness of cultural, religious, and self-care practices associated with CAM use are imperative to inform effective communication and counselling practices and promote evidence based self-care when patients present for advice. This narrative provides relevant discussions specific to different continents and regions historically linked to diverse CAM practices.

A multidimensional framework for rating health system performance and sustainability: A nine plus one ranking system.

BackgroundHealth Care provision in terms of prevention, detection and treatment is primarily dependent on the quality of the hosting Health System. In its health report 2000, the WHO's attempt to assess and rank health systems’ quality Worldwide was heavily criticized. We propose a novel framework for health system performance and ranking using three indicators for three domains; general health system performance, clinical outcome of treatment applied to the main causes of death and health system sustainability domains.MethodsEach domain was rated as “A – high”, “B – intermediate” or “C – poor” according to the aggregate score values of its three indicators. Hence the highest rank a health system can achieve is “AAA” and the lowest is “CCC”. If there is a need to define a “numerical rank” to further differentiate health systems with similar rating from one another, the total health expenditure per capita per year was used as an additional “number 10” indicator to achieve that level of differentiation. The framework was applied to Health Systems serving most of the World population including China, India, Brazil, USA, Russia, Germany, Japan, UK, France, Singapore and Switzerland. Data pertinent to each indicator was captured from published reports in peer-reviewed journals and/or from official websites. A Delphi survey was conducted for data not available online.ResultsAmong the 11 health systems tested, no one scored AAA, Switzerland, France, Germany and Japan scored AAB, Singapore scored ABB, UK scored BBB, USA, Russia and China scored BBC, Brazil scored BCC while India scored CCC. Total health expenditure per capita per year lead to ranking Switzerland first followed by France, Germany, and Japan.ConclusionThis novel ranking system is a practical and an applicable tool that test health system performance and sustainability. It can be utilized to guide all organizations, people and actions whose primary intent is to promote, restore or maintain health to achieve their targets. An International Health System Ranking database that will be hosted by the Institute of Global, Health, Faculty of Medicine, University of Geneva, Switzerland.

Impfen gegen Influenza – Internationale Bestandsaufnahme und Perspektiven für Deutschland

BackgroundThe current SARS-CoV-2 pandemic requires high influenza vaccination rates for the chronically ill in order to avoid additional strain on the health care system. Despite clear evidence of the safety and effectiveness of influenza vaccination, vaccination coverage has internationally remained at inadequate levels in recent years. The general practitioner is of central importance for the care of this population. Therefore, the aim of this systematic review was to evaluate various measures in general practice to increase seasonal influenza vaccination rates for the chronically ill, taking into account various international health systems. MethodsA systematic literature search was carried out in MEDLINE, CENTRAL, EMBASE and ERIC as well as manually in trial registers and literature lists. Only randomized controlled studies were taken into account. The methodology was defined in advance in a study protocol and published (PROSPERO CRD42018114163). ResultsA total of 14 studies within the framework of a national health service (United Kingdom), a state (Australia) and social (Switzerland) health insurance system and a private health care system (USA) were included in our review. Analog patient reminders and automated physician reminders as well as changes in professional roles have led to a significant increase in influenza vaccination rates, but only in the private health care system. In the national health service, none of the interventions we analyzed achieved a significant increase in vaccination rates, although the National Health Service in the United Kingdom documented relatively good basic influenza vaccination rates before the studies were carried out, regardless of the intervention. Good results were achieved in the social and state health insurance systems of Switzerland and Australia by training events for practice teams and SMS reminders. ConclusionsIn Germany, training events for medical teams and centrally organized invitation and monitoring systems might improve vaccination rates among the chronically ill. That the federal government pays for the vaccination costs seems to ensure a good basic influenza vaccination coverage for indicated patients in various health systems.

The impact of non-pharmaceutical interventions on SARS-CoV-2 transmission across 130 countries and territories

BackgroundNon-pharmaceutical interventions (NPIs) are used to reduce transmission of SARS coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). However, empirical evidence of the effectiveness of specific NPIs has been inconsistent. We assessed the effectiveness of NPIs around internal containment and closure, international travel restrictions, economic measures, and health system actions on SARS-CoV-2 transmission in 130 countries and territories.MethodsWe used panel (longitudinal) regression to estimate the effectiveness of 13 categories of NPIs in reducing SARS-CoV-2 transmission using data from January to June 2020. First, we examined the temporal association between NPIs using hierarchical cluster analyses. We then regressed the time-varying reproduction number (Rt) of COVID-19 against different NPIs. We examined different model specifications to account for the temporal lag between NPIs and changes in Rt, levels of NPI intensity, time-varying changes in NPI effect, and variable selection criteria. Results were interpreted taking into account both the range of model specifications and temporal clustering of NPIs.ResultsThere was strong evidence for an association between two NPIs (school closure, internal movement restrictions) and reduced Rt. Another three NPIs (workplace closure, income support, and debt/contract relief) had strong evidence of effectiveness when ignoring their level of intensity, while two NPIs (public events cancellation, restriction on gatherings) had strong evidence of their effectiveness only when evaluating their implementation at maximum capacity (e.g. restrictions on 1000+ people gathering were not effective, restrictions on < 10 people gathering were). Evidence about the effectiveness of the remaining NPIs (stay-at-home requirements, public information campaigns, public transport closure, international travel controls, testing, contact tracing) was inconsistent and inconclusive. We found temporal clustering between many of the NPIs. Effect sizes varied depending on whether or not we included data after peak NPI intensity.ConclusionUnderstanding the impact that specific NPIs have had on SARS-CoV-2 transmission is complicated by temporal clustering, time-dependent variation in effects, and differences in NPI intensity. However, the effectiveness of school closure and internal movement restrictions appears robust across different model specifications, with some evidence that other NPIs may also be effective under particular conditions. This provides empirical evidence for the potential effectiveness of many, although not all, actions policy-makers are taking to respond to the COVID-19 pandemic.

Observations from Transforming a Continuing Education programme in the COVID-19 Era and Preparing for the Future

ABSTRACT The COVID-19 pandemic has significantly disrupted and transformed continuing education in the health professions to be reliant on digital learning modalities. This retrospective observational study of a large, international health system’s continuing education programme compares educational activities offered, participation, and learning outcomes pre- and intra-pandemic to assess the impact of digitisation advanced because of the pandemic. There was a significant increase in internet-based activities that filled the gap of cancelled or postponed live, in-person activities to keep healthcare professionals up to date in their specialities and prepared to handle the clinical and hospital demands of the pandemic. Compared to live, in-person education, virtual activities were offered in shorter increments, reached a much larger amount of participants, and were equally effective in achieving learning outcomes. Questions remain regarding business model implications to generate adequate revenues to cover costs of virtual education. Additionally, there is a general inadequacy of digital learning environments to coalesce groups and meet social needs. Regardless, the efficiencies and effectiveness of digital modalities will be a primary method of teaching healthcare professionals going forward.